Method using central epidemiological database

ABSTRACT

Patient disease is diagnosed and/or treated using electronic data communications between not only the physician and his/her patient, but via the use of electronic data communications between the physician and one or more entities which can contribute to the patient&#39;s diagnosis and/or treatment, such electronic data communications including information that was priorly received electronically from the patient and/or was developed as a consequence of an electronic messaging interaction that occurred between the patient and the physician. Such other entities illustratively include a medical diagnostic center and an epidemiological database computer facility which collects epidemiological transaction records from physicians, hospitals and other institutions which have medical facilities, such as schools and large businesses. The epidemiological transaction record illustratively includes various medical, personal and epidemiological data relevant to the patient and his/her present symptoms, including test results, as well as the diagnosis, if one has already been arrived at by the e-doc. The epidemiological database computer facility can correlate this information with the other epidemiological transaction records that it receives over time in order to help physicians make and/or confirm diagnoses as well as to identify and track epidemiological events and/or trends.

This application is a continuation of application Ser. No. 08/428,988,filed on Apr. 26, 1995, now abandoned.

BACKGROUND OF THE INVENTION

The present invention relates to the delivery of medical services.

More and more people have begun to use electronic datacommunications--such as electronic mail, or e-mail--as a means ofcommunication with others. Indeed, patients and doctors have begun tocommunicate in this way. See, for example, "Can't reach your doctor? TryE-mail," U.S. News and World Report, Feb. 13, 1995, p. 82. This isadvantageous from the patient perspective because it avoids suchphenomena and petty annoyances as long waits in the doctor's waitingroom, the risk of picking up infections from other patients, etc.Doctors who use e-mail report that it enables them to, for example, havea chance to think through their responses to patient questions.Moreover, both doctors and patients put the elimination of "telephonetag" high on their lists of the advantage of this type of doctor/patientinteraction.

Another advantageous aspect of electronic communication in the medicalcontext is the emergence of various on-line services available tophysicians and/or consumers which can help diagnose and recommendtreatments for diseases-particularly rare diseases with which thetypical family practitioner may not be familiar.

Also known in the prior art is the notion of the "virtual patientrecord," as described, for example, by David Bennahum in "Docs forDocs," Wired,, March, 1995. Bennahum describes the notion of takingpatient records out of paper form and putting them into "mobile bundlesof bits that can be easily shipped around the country, from hospital todoctor to pharmacy to insurance company."

SUMMARY OF THE INVENTION

I have recognized that current medical delivery systems have only begunto scratch the surface in terms of ways in which existing electronicdata communications technology can be used to more efficiently andeffectively bring the body of medical knowledge and skill, as well asrelevant epidemiological considerations, to bear on the diagnosis andtreatment of disease and illness.

In accordance with the present invention, the process by which patientdisease is diagnosed and/or treated using electronic data communicationsis enhanced via the use of a epidemiological database computer facilitywhich collects so-called epidemiological transaction records fromphysicians hospitals and other institutions which have medicalfacilities, such as schools, large businesses, shopping malls, religiousinstitutions, military bases, and prisons. At least some of theepidemiological transaction records illustratively include variousmedical, personal and/or epidemiological data relevant to a patient and,typically, a presented set of symptoms. An epidemiological transactionrecord may further include test results, as well as the diagnosis, ifone has already been arrived at by the entity transmitting theepidemiological transaction record. The epidemiological databasecomputer facility can correlate this information with the otherepidemiological transaction records that it receives over time in orderto discern the occurrence of various epidemiological events and/ortrends. It can then provide useful diagnostic information to physiciansor other health care professionals in response to the transmission tothe epidemiological database computer facility of epidemiologicaltransaction records for which help is sought in either arriving at, orconfirming, a diagnosis. For example, if a food poisoning epidemicbreaks out in a particular locale, the epidemiological database computerfacility--as it begins to receive from that locale epidemiologicaltransaction records in which "food poisoning" is listed as being atleast the tentative diagnosis--in a position to return an electronicdata communication to a physician submitting such a patient transactionrecord a suggestion that food poisoning be considered as a likely sourceof the patient's problems.

In accordance with a feature of the invention, the epidemiologicaldatabase computer facility may include a process which continuously orregularly scans epidemiological transaction records that it has receivedlooking for epidemiological transactions that are incomplete, e.g.,transactions for which the outcome (e.g., "recovered after five days")is not recorded. Upon finding such records, the facility may send anelectronic communication to the originating physician or to the patientdirectly in an attempt to obtain the missing information.

In accordance with another feature of the invention, the epidemiologicaldatabase computer facility may continuously or regularly monitor itsentire collection of epidemiological transaction records looking for theknown signatures of particular respective diseases of epidemiologicalinterest, e.g., influenza, tuberculosis, bronchitis, strep throat,Legionnaires disease, AIDS, hepatitis, food poisoning, or particularknown virulent viruses, such as ebola and other filoviruses.

By being able to identify the geographical and sociological distributionof such diseases, the epidemiological database computer facility canserve as a valuable tool in helping public health officials, such as theCenters for Disease Control in Atlanta, Ga., a U.S. GovernmentAgency--carry out out its charter of reporting and/or suggestingtreatment modalities for such diseases. The epidemiological databasecomputer facility could, in a very straightforward way, look forpatterns in the data in an attempt to identify epidemiological eventssuch as an outbreak of food poisoning in a particular locale.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 shows an illustrative system in which the present invention isperformed;

FIG. 2 shows a flowchart of activities undertaken in the system of FIG.1;

FIG. 3 shows interactions between two of the entities shown in FIG. 1,specifically the so-called e-doc office and the so-called LocalLab;

FIG. 4 shows patient records in a database maintained within thecomputer located at the e-doc office;

FIG. 5 shows patient transaction records in a database maintained withinthe computer located at the e-doc office;

FIG. 6 shows epidemiological transaction records collected in a databasemaintained within a computer located at another one of the entities,specifically the Centers for Disease Control (CDC); and

FIG. 7 is a conceptual view of a computer located at CDC.

DETAILED DESCRIPTION

FIG. 1 shows a number of entities involved in the delivery of healthcare, all interconnected via respective links to a communicationsnetwork, illustratively the so-called Internet. More specifically, theFIG. 1 shows Internet 10 itself to which are connected to a personalcomputer 111 at the residence of a patient 11; a personal computer 121at the office of a physician 12 who delivers medical services for atleast a segment of his/her patients using the principles of the presentinvention--referred to herein as an "electronic doctor," or e-doc; apersonal computer 131 at a pharmacy 13; a personal computer 141 atdiagnostic center 14, which illustratively carries out medical tests ofthe type which requires expensive equipment, such as CT scanners, MRImachines, etc.; a personal computer 201 at a hospital 20; a personalcomputer 191 at ambulance service 19; and a time-shared minicomputer 151at medical data base service 15 which is available to physicians and/orconsumers to help diagnose and recommend treatments fordiseases--particularly rare diseases with which the typical familypractitioner may not be familiar.

Also connected to the Internet are computers at two further entitieswhose presence in this system play a central role in the carrying out ofthe invention. One of these is a mainframe computer 161 at the Centersfor Disease Control 16 in Atlanta, Ga.--an agency of the United Statesgovernment. The other is a personal computer 171 at small medicalfacility 17, which I refer to as a LocalLab. The latter serves as aconvenient, easily accessible facility at which routine medical testscan be performed such as blood tests, throat cultures, urinalysis, etc.LocalLab 17 may exist exclusively to perform such tests or,alternatively, could be a walk-in so-called medical emergency officewhich, in addition to performing such tests, includes on-staffphysicians who treat walk-in patients.

Also connected to Internet 10 is a personal computer 181 at institution18, which is a school, business, shopping mall, religious institution,military base, prison, or other institution which has an on-site nurse,medical department, etc.

It will be realized that, with the exception of CDC 16 and, perhapsmedical database service 15, each of the entities depicted in FIG. 1 isrepresentative of many similar such entities (e.g., multiple e-doclocations) dispersed throughout a community or, indeed, the country orthe world.

In preferred embodiments, at least some of the aforementionedcomputers--particularly those located at patient and e-doc locations,are capable of supporting concurrent voice and/or video communicationscurrently with the data communications so that the patient and e-doc cancommunicate aurally and/or visually in real time as needed. Typically,the data and voice/video communications will be displayed and/or managedin respective "windows" displayed on the various computer screens.

Assume now that patient 11 has a medical problem and wishes to consultwith e-doc 12 to obtain advice and/or treatment. To this end, thepatient initiates a data call from the patient's personal computer 111to the e-doc's computer 121. As shown in the flowchart of FIG. 2, thee-doc computer initially receives the incoming call from the patient atblock 21. The patient is then prompted for a patient ID number so as todetermine whether this patient has a pre-existing relationship withe-doc 12. If, as determined at block 23, this is new patient, thecomputer prompts the caller for a patient history and other information(block 24), thereby obtaining such data as name, address, billing andinsurance information, and previous illnesses and surgeries. Otherwise,the computer proceeds to retrieve the pre-existing patient record atblock 27. Ignoring block 28 for the present, an identification numberfor this call--referred to herein as a "transaction number" is nowgenerated at block 31. For reasons that will become apparent as thisdescription continues, the transaction number is globally unique,meaning that this number uniquely distinguishes this transaction fromany other transaction initiated at this or any other e-doc location.

At this point, the e-doc computer 121 begins to execute a software-basedmedical expert system of known type, as indicated at block 33. Thissystem prompts the caller for symptoms and, following an internal logictree, asks follow-up questions design to elicit all the informationnecessary for the medical expert system itself, or for the e-doc to(hopefully) arrive at a diagnosis as to what ails the patient.

As part of this interaction, a human attendant, such as a nurse orperhaps the e-doc himself, may come onto the connection using the voiceand/or video capabilities of the patient's and e-doc's computers if theexpert system determines that this is appropriate. Indeed, in thepatient/e-doc communications described below, any interaction betweenthe patient and e-doc's office may include real-time voice and/or videoconversations between the patient and the e-doc instead of, or inaddition to, a text-based interaction. Such real-time conversations maybe initiated by, for example, the e-doc computer, as just suggested, orby the patient, who may provide an indication during a text-basedinterchange that a human-to-human interaction is desired. Thus, it is tobe understood that any indication hereinbelow of information and/orinstructions given by e-doc 12 to patient 11 (e.g., "go to LocalLab 17for a blood test") may be accomplished by a textual message or in areal-time voice and/or video conversation.

Once the interaction with the medical expert system has been completed,a second, epidemiological expert system is invoked, as indicated atblock 35. This system is designed to elicit information from the patientwhich may be significant from an epidemiological standpoint. The use ofsuch information will become clear as this description continues. Thus,for example, the epidemiological expert system may ask the caller wherehe/she has eaten recently and what was eaten; whether he/she hastraveled recently and, if so, to where and when; the name of a cruiseship on which the caller may have traveled during the trip; the name ofany professional meeting or conference that may have been attended; etc.The epidemiological expert system may be stored directly on the e-doc'scomputer. Alternatively, that computer might electronically couple in toits interaction with the patient an epidemiological expert systemresiding on another computer, such as CDC computer 161. An advantage ofthat approach is that the CDC computer, being aware of certainepidemiological events that are going on in the country at that time byvirtue of its analysis of recently received epidemiological transactionrecords, as described below, can tailor the questions that it asks basedon that knowledge.

Based on the information thus elicited, a number of diagnostic scenariosare possible. As shown at block 37, it may be determined that thesymptoms reported are "harmless," that is, not evidencing any disease ordisorder that needs treatment. If this is the case, the caller is soinformed and, as indicated at block 49, the patient account is billedand the session is terminated.

Assuming that the symptoms are not "harmless," it is then determinedeither by the medical expert system executing within computer 121, or bye-doc 12, whether a consultation is desirable. A consultation may bedesirable either because, based on the information at hand, thediagnosis of the medical problem afflicting the caller is not clear orbecause confirmation of a tentative diagnosis is desired. Assume, on theone hand, that further consultation is not required. Assume, moreover,that, as determined at block 58, the problem is one for which it appearsthat physical examination by a doctor or hospital is required, e.g., itappears that the patient may be experiencing a coronary event. In thatevent, then the patient will be instructed, as indicated at block 44, toeither a) proceed to a doctor's office--doc's office or some other, b)go to a hospital, or c) await the arrival of an ambulance from ambulanceservice 19, which the e-doc will summon e-mail or via a regular voicetelephone call.

If, as now determined at block 47, the patient's condition has possibleepidemiological implications, e.g., it is an apparent illness as opposedto, for example, a broken bone, a so-called "epidemiological transactionrecord" described in further detail below is transmitted to CDC computer161 at block 48, and whether or not that is the case, the e-doc'scomputer finally proceeds at block 49 to a) bill the patient's accountand b) terminate the transaction.

Returning to block 41, assume that e-doc 12 wishes to consult withmedical database service 15 before rendering a diagnosis. E-doc 12 willinform patient 11 that he/she needs some time to confirm a diagnosis andwill invite the patient to either a) maintain the connection (whilee-doc accesses service 15 or even possibly CDC 16 as described below) orb) to terminate the call at this time with an indication that either thepatient should call e-doc again later or that e-doc will call thepatient back. E-doc 12 will thereupon connect to, and interact withmedical database service 15, as indicated at block 53. Based on thatinteraction, e-doc 12 may determine as indicated in block 54 thatfurther consultation is not needed but that, rather, the process canimmediately proceed to either a) patient referral to a doctor orhospital at block 58 or b) physical tests at block 65. If that is thecase, the patient is given instructions along these lines--eitherimmediately if the original connection had been maintained, or in thesubsequent call made to or by the patient

Assume, however, that even further consultation is desired-again eitherbecause the diagnosis is still not clear or because e-doc 12 simplywishes to have further verification of a tentative diagnosis. In thiscase, CDC computer 161 may be consulted, as indicated at block 55. TheCDC computer may include, for example, a more sophisticated expertsystem of the type used by database service 15. More importantly,however, the CDC computer may be able to provide a diagnosis based onepidemiological phenomena that it has been able to discern based onepidemiological transaction records that have been sent to it by e-docs,hospitals, etc., over the recent past. Although this is described inmore detail hereinbelow, a key example is the case where the patient'ssymptoms are consistent with diagnoses that have already been confirmedfor patients in patient 11's geographical area, e.g., an outbreak offood poisoning in the local area.

If, as determined at block 63, the diagnosis is still not clear at thispoint, or if the diagnosis is clear but indicates that this is somethingthat e-doc 12 cannot treat per block 58, the patient is, again, sent toa doctor or hospital at block 44, followed by billing and calltermination at block 49. Otherwise, the process proceeds to block 65, atwhich it is determined whether it is desirable to have certain physicaltests performed either at diagnostic center 14 or LocalLab 17. In thepredominant number of the cases, the facilities of LocalLab 17 will beadequate, LocalLab 17 being equipped to perform a wide range ofconventional medical tests--blood, urine, sputum, etc--as well as toprovide inoculations, e.g., tetanus, if these are indicated.

Assuming that the services of diagnostic center 14 or LocalLab 17 areindicated, the patient is directed by e-doc 12, as indicated at block67, to proceed thereto in order to obtain the necessary tests and/orinoculations. E-doc 12 will, concurrently, notify LocalLab 17 via e-mailto expect the patient. The e-mail message, more particularly, willspecify the tests and/or vaccines desired, as well as the transactionnumber and patient identification data. As shown more particularly inFIG. 3, LocalLab 17, upon obtaining the test results and/or performingthe desired inoculations, will transmit an e-mail message back to e-doc12, giving test results and/or confirming the administration of theinoculations, in a return message which also includes the transactionnumber. (The test results could be, for example, in text form, e.g, ablood count, or could be a digitized/encoded image e.g., of an X-ray.)E-doc's computer 121, upon receiving the information, inserts it intothe transaction record and forwards a copy of an updated epidemiologicaltransaction record, as described below, to CDC 16.

Patient 11 will have been instructed to re-contact e-doc at anappropriate time after the tests have been administered and e-doc'scomputer 121 will receive the new call at block 21. Since a transactionis in progress, as determined at block 28, the process will pick up atblock 65 when the patient calls back. It may be the case that furthertests physical tests are needed, and the sequence of steps indicated byblocks 65 and 67 may be repeated one or more times. Ultimately, however,all tests that are needed will have been completed. If the diagnosis isstill not clear at this point, as determined at block 69, referral isagain made to a doctor or hospital at block 44, followed by billing andterminating the call at block 49.

Otherwise, with the diagnosis now being clear to e-doc 12 based on thedescribed symptoms and/or test results, the process proceeds to block 71at which point the patient is informed of the diagnosis and isinstructed about his/her treatment. Advantageously, since thecommunications can be in textual form--at least in part--a comprehensivedescription of exactly what the patient is to do under a variety ofsituations that may arise during the recovery period can be provided to,and indeed captured by, the patient's computer 111 for later reference.Moreover, because e-doc 12 has access to records of a large number ofsimilar cases--both from his own computer and/or CDC's, quite preciseinformation can be given to the patient about such matters as theexpected duration of his/her illness and the likely severity undernormal circumstances of the symptoms on each day of the illness.

Finally, if medications are to be prescribed as detailed at block 73,then as indicated at block 75 a prescription can be e-mailed to pharmacy13 tagged with the transaction number and patient data and the patientdirected to pick up his/her medication thereat.

E-doc computer 121 includes at least two databases. As shown in FIG. 4,one of those databases contains individual patient records.Specifically, there is a database record for each patient which includessuch fields as a patient identification number (ID), such conventionallyrequested patient information as the patient name and address andbilling (and insurance) information, as well as the patient's preferredpharmacy, nearest LocalLab location, etc. Advantageously, moreover, apatient record illustratively also includes a wide range of demographicinformation which may be of value to the CDC computer in terms ofidentifying epidemiological trends among certain segments of thepopulation. Thus the demographic data in the patient record may includenot only such information that is typically found in a doctor's patientrecord as height, weight, sex, etc, but also such further demographicinformation as occupation; avocations; dietary peculiarities;information about the person's residence, such as the type of heatingsystem used, nearness to high-voltage power lines; whether the persondoes or used to smoke; whether the person uses a portable cellular phoneetc. any of which might have epidemiological ramifications. Thisinformation, combined with answers to questions solicited at blocks 33and 35, as described above, could be meaningful in terms of the CDCcomputer discerning epidemiological trends. The patient record alsoillustratively includes the patient identification numbers of members ofthe patient's family, which may also be relevant in diagnosis since, forexample, members of a particular family or household may tend to havesimilar medical problems and/or susceptibilities.

Another database in the e-doc's computer is shown in FIG. 5. Thisdatabase contains so-called patient transaction records--one for eachnew transaction represented by the flowchart of FIG. 2. Each patienttransaction record includes the aforementioned transaction number; apointer to the patient record for the patient in question stored in thepatient record database; and a so-called transaction trail. The latteris simply a listing of all the steps performed per the flowchart of FIG.2, as well as all associated data that may have been gathered including,for example, symptom information, epidemiological information that wassolicited, test results, medications prescribed, and diagnoses. Thevarious elements of the transaction trail are date- and time-stamped andare added to the patient transaction record as the steps are performedand/or the associated data, e.g., test results, are received by thee-doc computer. Advantageously, the transaction record should alsoinclude follow-up and outcome information so that particular sets ofsymptoms and courses of treatment can be correlated with othertransaction records either within the e-doc's computer or CDC computer161, as described more fully below.

FIG. 6 depicts a database within CDC computer 161 containing what Irefer to as "epidemiological transaction records," specifically,epidemiological transaction records that have been sent to computer 161over some predefined period of time, e.g., three months.

An epidemiological transaction record contains information taken bothfrom patient records and transaction records created and stored in, forexample, e-doc computers. As shown in FIG. 6, an epidemiologicaltransaction record includes the transaction number; an abbreviatedpatient record, which comprises patient record information that has beenedited to exclude epidemiologically irrelevant information and toprotect the anonymity of the patient; and the aforementioned transactiontrail. Whenever block 48 is encountered in the course of the executionof the process depicted in FIG. 2, and whenever any new information isentered into a patient transaction record in e-doc computer, a newepidemiological transaction record is automatically sent to CDC computer161, which thereupon replaces its old copy of the record for a new one.

FIG. 7 is a conceptual view of the CDC computer. The computer includesthe aforementioned patient transaction record database 78 and a numberof computer processes executing in the computer. One of these processesis a so-called daemon 80 which continuously scans the patienttransaction records looking for incompleted patient transactions, e.g.,transactions for which the outcome (e.g., "recovered after five days")is not recorded. Upon finding such records, the daemon sends e-mail tothe originating e-doc or the patient in an attempt to obtain the missinginformation.

Also executing within the CDC computer are a plurality of query/answerprocesses 82, each of which services an ongoing call from (typically) ane-doc seeking information, per block 55. In addition, a plurality ofprocesses 84 each continuously monitors the entire database of patienttransaction records looking for the known signatures of particularrespective diseases of epidemiological interest, e.g., influenza,tuberculosis, bronchitis, strep throat, Legionnaires disease, AIDS,hepatitis, food poisoning, or particular known virulent viruses, such asebola and other filoviruses. By being able to identify the geographicaland sociological distribution of such diseases, CDC is in a betterposition to carry out its charter of reporting and/or suggestingtreatment modalities for such diseases. Additionally, an epidemicwatchdog process 86 looks for patterns in the data in an attempt toidentify epidemiological events that are not otherwise monitored byprocesses 84. One or more of processes 84 could be simply a processwhich correlates specific diagnoses in patient records, e.g. "foodpoisoning" with their geographical locations.

The foregoing merely illustrates the principles of the invention andmany implementational variations are possible.

For example, a patient transaction record may be initiated not only atan e-doc office, but also at, for example, an institution 18--such as aschool or business--at such time as when a student or employee mayreport in to the school nurse or company medical department with medicalsymptoms of one kind or another. Although the school nurse or medicaldepartment may not provide medical diagnosis or treatment to the person,the sending of an epidemiological transaction record containing, forexample, patient information and symptom descriptions from theinstitution's computer 181 to CDC computer 161 may provide the latterwith useful information for identifying epidemiological events, asdescribed below.

Moreover, if desired or necessary, the initial contact between a patientand an e-doc may be required to be an in-person meeting in the e-doc'soffice rather than via an electronic communication. If desired ornecessary, the patient could be asked to sign a waiver at that timeindicating that he/she understands the limitations of renderingdiagnoses using electronic data communications, such as e-mail, andagrees to not hold e-doc liable for any misdiagnoses that might havebeen avoided by an office visit.

Additionally, instead of connections being made via the Internet,various entities, e.g., a patient and an e-doc, can connect with eachother directly via direct modem dial-in.

Moreover, it may be possible for various simple diagnostic tests orprocedures to be performed by the patient him/herself, with real-timeread-out being provided to the e-doc. For example, the patient may havea stethoscope unit connected into his/her personal computer and canplace the stethoscope at particular locations on his/her body under thedirection of the e-doc during a real time voice and/or videocommunication, with the output of the stethoscope being electronicallycommunicated directly from the patient's computer into the e-doc'scomputer. Blood pressure or other tests could be similarly performed bythe patient. It might even be possible for the patient to use afiber-optic-based-instrument which would allow the e-doc to observe thepatient's throat, ear canal, etc., via a video connection. To the extentthat the patient is not able to manipulate these devices by him/herself,this could obviously be done by a family member or even by a "roving"nurse employed by the e-doc to visit the patient.

It will thus be appreciated that although the invention is describedherein in the context of particular illustrative embodiments, thoseskilled in the art will be able to devise many varied arrangementsembodying the principles of the invention without departing from theirspirit and scope.

I claim:
 1. An epidemiological database computer method comprising thesteps ofreceiving, and storing in a memory, epidemiological transactionrecord information received over a predetermined recent timeframe in amultiplicity of first electronic data communications, saidepidemiological transaction records each including epidemiologicalinformation about a respective patient, a description of medicalsymptoms exhibited by that patient, and a diagnosis of a medicalcondition of that patient, receiving an incoming second electronic datacommunication having symptom information and epidemiological informationabout an individual patient, and transmitting to the source of saidsecond electronic data communication an electronic data communicationwhich describes at least one diagnosis which is the same as thediagnosis contained in at least one of said epidemiological transactionrecords, said at least one epidemiological transaction record includingsymptoms and epidemiological information which correspond to thoseincluded in said second electronic data communication.
 2. The method ofclaim 1 wherein a portion of said epidemiological information beingselected from the group consisting of meal information, travelinformation, information concerning recent activities, and demographicinformation.
 3. The method of claim 1 wherein a portion of saidepidemiological transaction records has incomplete information andfurther comprising transmitting, to the source of each saidepidemiological transaction record, a third electronic communication toobtain said incomplete information.
 4. The method of claim 1 furthercomprising scanning said epidemiological transaction records for knownsignatures of particular respective diseases.
 5. An epidemiologicaldatabase computer method comprising the steps ofreceiving, and storingin a memory, epidemiological transaction records information received ina multiplicity of first electronic data communications, saidepidemiological transaction records each including epidemiologicalinformation about a respective patient, a description of medicalsymptoms exhibited by that patient, and a diagnosis of a medicalcondition of that patient, receiving an incoming second electronic datacommunication having symptom information and epidemiological informationabout an individual patient, a portion of said epidemiologicalinformation being selected from the group consisting of mealinformation, travel information, information concerning recentactivities, and demographic information, and transmitting to the sourceof said second electronic data communication an electronic datacommunication which describes at least one diagnosis which is the sameas the diagnosis contained in at least one of said epidemiologicaltransaction records, said at least one epidemiological transactionrecord including symptoms and epidemiological information whichcorrespond to those included in said second electronic datacommunication.